ENEMATA.

What are enemata?

Enemata are liquids injected into the rectum. They may be nutritive, cathartic, or forced enemata.

Nutritive enemata are used to nourish the patient when the stomach cannot retain or digest food. They should be small in amount, not exceeding f3iij-iv (90.0-120.0) at a time, nor should. they be too frequently repeated, else they will cause irritability of the rectum. They should be combined with some digestant, as pepsin or pancreatin.

Cathartic enemata are used to unload the bowels when irritation or inflammation of the stomach is present; to aid the action of cathartics taken by the mouth; to remove fæcal accumulations or retained and irritating secretions from the large intestine; to relieve tympanites; to remove ascarides; or to act as revulsives. The fluid used may be cold or warm water, either simple or medicated, and the quantity will depend on the case. The injection should be made slowly and carefully, and the introduction of air is to be avoided.

Forced enemata are made slowly and gradually, the fluid, either warm water or warmed oil, being poured into a large funnel or rubber bag (fountain syringe) to which a long rubber tube is attached, armed with an injection pipe. By elevating the funnel or bag the fluid flows in a steady stream, the force being regulated by the height at which the bag is held. Forced enemata are employed principally to reduce intussusception of the bowels.

ORDER V.-ANTHELMINTICS.

What are anthelmintics?

Anthelmintics are medicines used to kill (vermicides) or cause the expulsion of (vermifuges) intestinal worms.

How are they administered?

They should be given fasting, and should be followed in 4 to 6 hours by a purgative, as calomel or castor oil.

Describe the medicines used as anthelmintics.

SPIGELIA, or pinkroot, the rhizome and roots of S. marilandica or Carolina pink (Nat. Ord. Loganiaceae), contains a bitter principle,

volatile oil, resin, tannic acid, etc. It slows the heart by stimulating the inhibiting centres, reduces arterial pressure by depressing the heart, and in overdoses quickens the pulse, increases the bloodpressure, dilates the pupil, causes delirium, and, in fatal cases, death from respiratory paralysis. It is very efficient in causing the expulsion of lumbrici, but should be followed by a purge. Dose of the fluid extract (extractum spigelia fluidum) f3j-ij (4.0-8.0), or to a child gtt. x (0.5) on sugar.

CHENOPODIUM or American wormseed, the fruit of C. ambrosioides or Jerusalem oak (Nat. Ord. Chenopodiacea), contains a volatile oil, to which its effects are due. It is a very efficient remedy for the expulsion of lumbrici, and should be followed by a brisk cathartic. The oil (oleum chenopodii) is given in doses of gtt. v-x (0.25-0.5) on sugar, to a child 3 years old, before meals.

SANTONICA or Levant wormseed is the unexpanded flower-heads of Artemisia pauciflora (Nat. Ord. Compositæ). The active principle is santonin. Large doses cause salivation, rapid breathing, slow, labored pulse, trembling, yellow vision and yellow urine, unconsciousness, convulsions, dilated pupils and death. It is used almost exclusively as a remedy for lumbrici. Dose of santonin (santoninum) for an adult gr. ss-v (0.03–0.3); for a child 2 years old gr. (0.016). Troches of santonin (trochisci santonini) each contain gr. ss (0.03) of santonin, dose 1 to 6 troches.

ASPIDIUM, the rhizome of Dryopteris filix-mas, or male fern, and D. marginale (Nat. Ord. Filices), contains filicic acid, volatile and fixed oils, resin, etc., and is used as a taniacide. Like all remedies employed for this purpose, its administration should be preceded by a fast of 24 hours and followed by a brisk cathartic. In over: doses it has caused death from enteritis. Dose of the oleoresin (oleoresina aspidii) f3ss-j (2.0-4.0).

GRANATUM (pomegranate), the bark of the stem and root of Punica Granatum (Nat. Ord. Lythraries), contains four alkaloids, pelletierine and three allied alkaloids, which are powerful tœniacides, as is also granatum itself. In overdoses they are said to act on the muscles like woorara. Dose of pomegranate in decoction (3ij (59.147) to water Oij (946.358) boiled to Oj (473.179)) fzij (59.147) repeated 3 times at an hour's interval, before breakfast; of pelletierine tannate gr. v−x (0.3-0.6).

Cusso (Kousso; Brayera, Pharm. 1880), the female inflorescence of Hagenia abyssinica (Nat. Ord. Rosacea), contains protokosin (a crystalline, inactive resin) and kosotoxin (an amorphous, highly active resin), and is used as a tœniacide; dose of the fluid extract (extractum cusso fluidum), f3ij-iv (8.0–15.0).

KAMALA, the glands and hairs from the capsules of Mallotus philippinensis (Nat. Ord. Euphorbiaceae), contains rottlerin and isorottlerin, resinoid substances, and is used as a tæniacide; dose 3j-ij (4.0-8.0) of the powder in syrup, or given in the form of tincture.

PEPO (pumpkin-seed), the seed of the Cucurbita pepo or pumpkin (Nat. Ord. Cucurbitaceae), contains a resin, and is one of the most powerful taniacides in the materia medica and perfectly harmless; dose of the fresh seed (powdered with sugar) 3j-ij (30.0–65.0).

OLEUM TEREBINTHINÆ (oil of turpentine) is an efficient but not a harmless remedy for tania and lumbrici. It will be found under the head of " Diuretics." Dose f3ss-j (15.0-30.0) combined with castor oil.

HYDRARGYRI CHLORIDUM MITE (mercurous chloride or calomel) is used alone or combined with other anthelmintics for the expulsion of lumbrici and (rarely) tania. It should be given in full purgative doses (v. Alteratives).

What remedies are used for the destruction of ascarides?

Mild purgatives, as calomel or sulphur, may be used to dislodge them from the small intestines, but injections of quassia-infusion, common salt, naphtol, tannin, alum or lime water must be employed to get rid of those in the colon. Injections of sweet oil at bedtime are useful to kill any which may be in the rectum, and prevent the excessive itching which they cause. The child should be prevented from scratching the anus, as the ova are very tenacious, and adhering to the finger nails may be conveyed to the mouth and reproduce the trouble.

What are useful adjuncts to the anthelmintics?

Iron and the bitter tonics, by restoring tone to the mucous membranes, prevent the excessive secretion of mucus which forms a suitable nidus for the development of parasites.

Class III.-Medicines acting on the body by their effect on the various secretions

and excretions.

ORDER I.-DIURETICS.

What are diuretics?

Diuretics are medicines used to increase the excretion of urine. acting either directly on the secreting cells of the kidney, or indi rectly by their influence on the blood-pressure in the glomeruli.

For what purposes are they used?

They are used (1) to maintain the function of the kidneys in suppression of urine independent of the cause; (2) to promote the excretion of urinary solids (injurious waste products) or of poisons from the blood, as in uræmia, gout, rheumatism, fevers, and in cases of various metallic and vegetable poisons; (3) to promote the excretion of water, thus tending to dilute highly concentrated urine or to aid in the removal of effused (dropsical) fluids; and (4) to alter the chemical reaction of the urine and render that fluid more bland, thus lessening vesical and urethral irritation and any tendency which may exist to the formation of calculi.

A certain relation exists between the functions of the skin, kidneys and bowels, so that free catharsis or free diaphoresis will diminish the urinary secretion and vice versa.

How may diuretics be classified?

They may be divided into alkaline, hydragogue and alterative diuretics.

ALKALINE DIURETICS.

What are the alkaline diuretics?

They are those salts which, without materially increasing the amount of water, usually increase the elimination of its solid ingredients and modify or alter its chemical reaction.

Name the alkaline diuretics.

The potassium and lithium salts, and strontium lactate.

POTASSIUM.

What is the source of potassium?

Potassium is obtained from the ashes of plants, from native nitre, and from tartar or argol, deposited from wine during fermentation. What are the general physiological actions of its salts?

Locally applied caustic potash destroys tissues by abstracting water, dissolving albumin and saponifying fats. Internally in small doses before meals, they increase the acidity of the gastric juice; in large doses, or after meals, they neutralize the acid present in the stomach. The bicarbonates, when taken on an empty stomach, enter the blood readily, and abstracting the base from basic and neutral potassium phosphate convert it into the acid phosphate, thus increasing the acidity of the urine; but if taken after or during meals, they are decomposed in the stomach, and entering the blood as a carbonate, diminish the acidity of the urine. The salts formed with the vegetable acids are converted into carbonates in the system and render the urine less acid. Potassium and its salts promote oxidation (and hence cause emaciation when used continuously), decreasing the amount of uric acid and increasing the urea excreted by the urine. The nitrate and chlorate are not decomposed in the system, and having effects peculiar to themselves, will be separately considered. All the potassium salts are protoplasmic poisons, in very large doses paralyzing the heart in diastole by direct action on its muscle and contained ganglia. They also depress and paralyze the functions of the brain and spinal cord. They all prove diuretic, increasing the amount of water passed and, by promoting oxidation, the elimination of urea. Poisoning by caustic potash is due to its corrosive properties, and if recovery takes place from the acute effects, various stenoses are apt to follow. The carbonate in overdoses causes violent gastro-enteritis with great cardiac depression and sometimes paralysis. The treatment of potassium poisoning consists in neutralizing the alkali by a vegetable acid, giving demulcents and fixed oils as protectives, and stimulating if requisite.

What are the therapeutical uses of the potassium salts?

The potassium salts are used as diuretics (increasing as they do both the water and salts of the urine, and converting uric acid into